How the APGAR score works

The APGAR score is a quick and easy measurement of a newborn’s response to birth and life outside the womb — specifically, the fetal-to-neonatal transition.

The baby is assessed on five simple criteria (complexion, pulse rate, reaction when stimulated, muscle tone, and breathing) on a scale from zero to two. The five values are then summed up to obtain a score from zero to 10.

How does your baby score? From 0 to 10

Ratings are based on the following five factors:

A: Appearance (color)

0 for blue or pale all over
1 for pink with blue extremities
2 for pink overall

P: Pulse (heartbeat)

0 for absent (no pulse)
1 for under 100 bpm
2 for over 100 bpm

G: Grimace (reflex)

0 for non-responsive
1 for grimace with suction or strong stimulation
2 for cough, sneeze or cry with stimulation

A: Activity (muscle tone)

0 for limp
1 for some reflex
2 for active movement

R: Respiration (breathing)

Tallying up the totals

As you can see, for each factor, there is a score of 0 (poorest), 1 or 2 (best) which may be given. The score is taken at one and five minutes (sometimes also 10 minutes) after birth, the total high score being 10 and the lowest score a zero. Scores of 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 is considered generally normal.

According to a Norwegian study reported in the British Medical Journal in 2010, a low Apgar score was strongly associated with later diagnosis of cerebral palsy. The prevalence of cerebral palsy in children with Apgar score of less than 3 was more than 100-fold higher than in children with a score of 10. This association was high in children with normal birth weight and modest in children with low birth weight. Low Apgar score was also associated with all subgroups of spastic cerebral palsy, but the association was strongest for quadriplegia.

In an accompanying editorial, Professor Nigel Paneth from Michigan State University in the US says that a low Apgar score in a baby of normal weight “is an important clue that the baby has an increased risk of death and disability, even though most infants with such scores recover quickly and do well.”

Useful for birth – not for kindergarten

The American Academy of Pediatrics made a statement in 1996 regarding the use and abuse of the scoring system as anything other than a newborn assessment tool, noting, “Apgar scores are useful in assessing the condition of the infant at birth. Their use in other settings, such as collection of a child’s Apgar score at entry to school, is inappropriate.”

This scale was named for its creator, pediatrician Virginia Apgar (1909-1974), who introduced the system in 1952. Since she created the ‘backronym’ with her name, it is perhaps fortunate her name was not more along the lines of Virginia Keihanaikukauakahihuliheekahaunaele (considered one of the longest surnames in America).

Myria, originally launched in 1998, strives to deliver more conversation, and less gossip. More intelligence, less eye-rolling. More acceptance, less judgment. And throughout the site: more needle, less haystack. Through life's ups, downs, and everything in between, we want to encourage you, support you, and help guide you. The team behind Myria understands that status updates and selfies never tell the whole story, and that we all have stuff to deal with, and that's nothing you need to hide here. Beyond "been there, done that" - every day, we're still there and still doing it. That's how we know: You've got this.

Note: This article may feature affiliate links to Amazon.com or other companies. Qualifying purchases made via these links may earn us a small commission at no additional cost to you. Find out more here.

For you

Coloring books & more

Important to know

Affiliate disclosure: Myria participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to allow sites to earn advertising fees by advertising and linking to products or services offered by Amazon. Find out more here.

The content presented on the Myria site is of a general nature and is presented for educational and informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment; nor is it legal advice of any kind. Never disregard medical advice or delay seeking it because of something you have heard or read, online or off. Find out more here. Note: Some source materials may have been edited for content and length.